Hyperbaric oxygen therapy shows promise as treatment option for fistulizing CD

A recent study has demonstrated the safety and potential effectiveness of hyperbaric oxygen therapy (HBOT) in patients with fistulizing Crohn’s disease (CD).

“HBOT delivers 100-percent oxygen in a pressurized chamber, increasing tissue oxygen levels and regulating inflammatory pathways,” the investigators said. “Mounting evidence suggests that HBOT may be effective for inflammatory bowel disease.”

This systematic review was conducted to examine the efficacy and safety of HBOT in fistulizing CD. The databases of PubMed, Cochrane, Embase, and Web of Science were searched for relevant studies using the “Preferred Reporting Items for Systematic Reviews and Meta-analyses” criteria. Finally, the Cochrane Handbook guidelines were utilized to assess study bias.

Sixteen studies, including 164 patients, met the inclusion criteria. The pooled overall clinical response was 87 percent (95 percent confidence interval [CI], 0.70‒0.95; I², 0) and the pooled clinical remission was 59 percent (95 percent CI, 0.35‒0.80; I², 0) for all subtypes of fistula.

The overall clinical response rates were 89 percent for perianal, 84 percent for enterocutaneous, and 29 percent for rectovaginal fistulas. However, meta-regression revealed that hours in the chamber and the number of HBOT session were not significantly associated with clinical response.

Adverse events were rare, with a pooled rate of 51.7 per 10,000 HBOT sessions for all fistula types (95 percent CI, 16.8‒159.3; I², 0). In addition, the risk of bias was present across all studies.

“Randomized control trials are needed to substantiate the benefit of HBOT in fistulizing CD,” according to the investigators.